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Background:  Somewhat similar to breast implants testicle implants are available in either saline or silicone compositions. What differentiates silicone breast implants from silicone testicle implants is that in the breast the silicone implant is a gel-filled bag vs in the scrotum the implant is solid silicone.  While solid silicone will always feels a bit firmer than a gel-filled silicone implant, it will definitely feel softer than a saline-filled one.

A good question is if a silicone testicle feels softer and more natural than a saline implant, why do saline testicle implants even exist? The reason goes back to its connection with breast implant history. When all silicone breast implants were removed from clinical use in 1991 due to autoimmune concerns, along with it went every other silicone gel-based aesthetic implant. This ban included testicle implants. Since it was never clear if or when silicone breast implants would be permitted for clinical use again (it took 15 years until 2006) the saline-filled testicle implant was developed and eventually FDA-approved.

While the basis for its development was necessary a saline0fiuolled testicle implant  is far from ideal in the thin tissues of the scrotum. Besides its harder feel and that it can eventually rupture it has a fill valve on it. Even if the surgeon does not suture it into place (which is unnecessary) the valve allows the growth of scar tissue around it which fixes it unnaturally in place. This often gives it some unnatural mobility and a high position in the scrotum.  

Case Study: This male has a history of losing his left testicle due to torsion as a teenager. It was subsequently replace by a saline-filled testicle. After having it for over. A decade he was bother by its hard feel and high appearance. A revision was subsequently done which neither improved its feel or appearance. He now opted to have a silicone implant replacement.

Under general anesthesia and through a 3 cm low midline raphe incision the saline implant was exposed and removed. The saline implant and its 4.5cm solid silicone implant replacement were compared. Besides being softer the replacements implant was a bit wider in diameter.

The implant pocket was externalized so it could be released and expanded. Then the new silicone implant was passed through it into position. A four layer soft tissues closure was then done.

While the implant replacement has no significant size difference its softer feel and lower position in the scrotum assures that an aesthetic improvement will result.

Case Highlights:

1) Saline testicle implants often create a high hard feel to them.

2) Silicone testicle implants provide a softer feel than saline implants and don’t have any risk of deflation over a patient’s lifetime.

3) Standard size silicone testicle implants will work for almost all testicles lost due to medical reasons.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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